Franz Josef Seibert

External fixation in trauma of the foot and ankle.

External fixation as a modality is a versatile and minimally invasive stabilization option that should not be forgotten even as new and specially designed implants for nearly each bone become more fashionable. As a temporary traction device, the external fixator can help condition the soft tissues and, if closed reduction was sufficient, it can stay in place for definitive treatment. The external fixator can be used as an intraoperative distraction device and as a helpful tool for reduction, which can stay in place as a temporary immobilization. External fixation instead of plaster cast allows for better care of skin and soft tissues. External fixation also has its advantages as a minimally invasive external compression device in specific indications for arthrodesis, especially in infected cases.

Quality of life after pertrochanteric femoral fractures treated with a gamma nail: a single center study of 62 patients

BackgroundIntramedullary nailing of pertrochanteric femoral fractures has grown in popularity over the past 2 decades likely because this procedure is associated with a low risk for postoperative morbidity and a fast recovery of function. The evaluation of outcomes associated with pertrochanteric nailing has mainly been based on objective measures. The purpose of the present study is to correlate patients’ health-related quality of life results after intramedullary nailing of pertrochanteric fractures with objective outcome measures.MethodsWe conducted a single-center study including 62 patients (mean age 80 ± 10 years) with pertrochanteric fractures treated with a Gamma 3 Nail. Health related quality of life was measured using the Short Form-36. These results were compared to both US and Austrian age and sex-adjusted population norms. The objective outcome measures studied at one year postoperatively included Harris Hip Score, range of motion, leg length, body mass index, neck-shaft angle and grade of osteoarthritis.ResultsAccording to the Harris Hip Score 43 patients (67%) had excellent or good results. There was no significant difference in the average neck-shaft angle comparing affected hip to non-affected hip at 12 months postoperatively. The average osteoarthritis score, for both the injured and uninjured hip, did not differ significantly. We found significant differences between the bodily pain, social functioning and mental health subscales and two summary scores of the Short-Form 36 in comparison to Austrian population norms. Complication rate was 8%.ConclusionsThe results of this study confirm that intramedullary nailing with the use of a Gamma Nail is a safe treatment option for stable and unstable pertrochanteric fractures. Despite good functional and radiographic results we noticed a substantial fall off in patients’ quality of life up to 12 months after operation.

Die arthroskopisch unterstützte Osteosynthese distaler intraartikulärer Radiusfrakturen

ZusammenfassungOperationsziel Geschlossene Reposition und Stabilisierung von intraartikulären distalen Radiusfrakturen unter direkter Sicht auf die Gelenkfläche. Erkennung und minimalinvasive Behandlung von karpalen Zusatzverletzungen. Indikationen Distale, intraartikuläre Radiusfrakturen, vornehmlich der Gruppen B und C nach der AO-Frakturklassifikation.Frakturen der Gruppe A mit hohem Dislokationsgrad und Verdacht auf karpale Zusatzverletzungen (Skapholunäre und lunotriquetrale Bänder, Diskuskomplex). Kontraindikationen Offene Frakturen, polytraumatisierte Patienten, ausgeprägte intraartikuläre Trümmerzone. Operationstechnik Gedeckte Reposition. Handgelenkarthrographie; exakte Reposition der Fragmente unter arthroskopischer Kontrolle. Retention durch perkutan eingebrachte Kirschner-Drähte und/oder kannülierte Schrauben; u. U. Arthrodese des skapholunären Gelenkes und Resektion oder Refixation des Diskus. Weiterbehandlung Unterarmgipsverband oder gelenkü,bergrückender Fixateur externe für sechs bis acht Wochen, je nach Zusatzverletzung. Entfernen des Materials nach sechs bis acht Wochen. Kontrollarthrographie des Handgelenks vor Aufhebung der temporären skapholunären Arthrodese. Ergebnisse 30 Patienten wurden operiert; davon zeigten 23 karpale Zusatzverletzungen. 23 Patienten, deren Operation länger als mindestens ein Jahr zurücklag, wurden nach durchschnittlich 32,5 (zwölf bis 48) Monaten nachuntersucht und nach dem Punktesystem von Cooney bewertet. 16 Patienten zeigten ein exzellentes oder gutes, vier ein befriedigendes und drei Patienten ein schlechtes Ergebnis. Bei drei wurden flüchtige Parästhesien beobachtet, bei einem eine Irritation der Sehne des Musculus extensor pollicis longus. Bei zwei Patienten waren Sekundäreingriffe erforderlich; eine Ulnaverkürzung, eine Plattenosteosynthese des Radius.SummaryObjectives Closed reduction and internal fixation of intraarticular distal radial fractures under direct vision of the articular surfaces. Concomitant evaluation of additional carpal injuries, and, if necessary, minimally invasive treatment. Indications Distal, intraarticular radius fractures, particularly of group B and C according to the AO fracture classification.Fractures of group A with marked displacement with probable suspected additional carpal injuries, such as of scapholunate and lunotriquetral ligaments, triangular fibrocartilaginous complex. Contraindications Open fractures, polytrauma patients, comminuted intraarticular fractures. Surgical Technique Closed reduction of the fracture. Arthrography of the wrist. Exact reduction of the fragments under arthroscopic control. Stabilization of fragments using percutaneously introduced Kirschner wires and/or cannulated screws. If required, temporary arthrodesis of the scapolunate joint, or resection or reattachment of the articular disc. Results Thirty patients were treated with the described method, 23 of them showed additional injuries. Twenty-three patients who had surgery at least one year before were followed up at an average of 32.5 months (12 to 48) and were assessed according to the point score of Cooney. An excellent or good result was seen in 16 patients, a satisfactory result in 4 and a poor result in 3 patients. Transient paresthesia was noted in 3 patients, in 1 patient we observed an irritation of the extensor pollicis longus tendon. Two patients required revision surgery: 1 shortening of the ulna, 1 plate fixation of the radius.

A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

Various surgical techniques have been described for the fixation of acromioclavicular (AC) dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points), SPADI (0 points), and QuickDASH score (0 points). The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

Leak in Surgical Safety Checklist

Material and methods We report a case that has taken place in our department, supplemented by literature review. Modified WHO Safety Checklist has been used in our department since a couple of years ago. Although “Team Time Out” was performed standardly following unpleasant situation happened: after an elective arthroscopy, while the surgeon finished documentation, the responsible nurse informed him that the indicator strip for sterility did not show any discoloration. No one of the operating room personal knew whether the indicator strip was not checked or if it had been overlooked although a modified WHO Surgical Safety Checklist was performed carefully. Subsequently the question arose, what does it mean to the patient if surgical instruments were not sterilized but only cleaned by Washer-Disinfector.